Let’s Take Turns: Establishing a Dialogue

I raised my right hand and pointed my index finger to the sky. “Give me a moment to write that down,” hoping my client might stop talking. He seemed intent on a nonstop pouring out of his entire history as fast as a high speed train.

While writing I glanced up at him to make brief eye contact and exclaimed, “Before we go any further, I’d like to ask you a question.” He showed attention. ‘How would you like to feel about this session when you leave my office today?” He said, “I hadn’t thought about that.”  And in the next beat, he picked up where he leDialogue2ft off.

Clients come to therapy ready to tell their story.  Of course they do, and for many good reasons. Among them, to make sure you are listening and that you care.  Some are anxious to get the whole thing out at once so you can solve the problem as soon as possible.

Acknowledging the story, reflecting feelings, and delivering empathic reassurance is the backbone of any good therapy intervention. However, being solution focused means emphasizing what’s working in their lives, moving the conversation toward their preferred future, and calling out their strengths and past successes.

It’s natural for clients to think that you are singly interested in their history and their problems. Problems and brokenness have always been the dominant atmosphere in health care settings.

Solution focused counselors are interested in causality because we want to hear the context upon which to start a dialogue. We are interested in the past as a bejeweled mine, ready to be excavated for stories of strength and resilience. (“How have you coped? How do you think you’ve managed in light of all you’ve been through?”)

So let your client know from the very first contact that you are interested in a dialogue. If it’s the first session, avoid saying, “What brings you here today?” or, not even “How are you today?” Open ended questions can signal that you are ready to be an audience rather than a partner in dialogue.

It’s ok to start superficial and specific.  “How was your trip here today?  Did you find the office easily?” or, “What did you have to do to get yourself here today, the roads are usually jammed at this time of the day?”  These kinds of questions set the tone for solution building.  In effect, you are saying “You must really want to be here to get help. Look at all the things you did to actually get here.”

Questions and opening statements like these signal that you know your client wanted to get to their appointment and were successful.  Starting out the session with questions that point to the here and now helps you take charge of the conversation.  They initiate an exchange of information and could avoid the client (or you!) launching into a monologue.

This week and next, be aware of the first thing you say to clients after they have taken their seat.  What kind of conversation are you inviting?  Below, I have provided some starters.  If you have time, I’d love to hear some of your experiences with creating dialogue.  And if you have questions, ask away!

Next time, Part II:  How to start a dialogue with a quiet client, one who wants you to do the monologue.

Here are some starters:

“Thanks for coming on time.  What did you have to do today to make sure that happened?”

“Where did you just come from? …. what’s been the easiest part of your day so far?”

“When you thought about coming here today, what kinds of things came to mind?”

“What were your thoughts as you were traveling here today?”

“I’m glad you made it.  Tell me a little about your day so far.”







Solution Focused = Future Focused

“Stay present.” “One day at a time.” “Be here now.” “Focus on today, tomorrow will take are of itself”  When these phrases are used to comfort, they may help shift someone’s mood for a moment or two. But more often than not, they don’t inform or instruct.up next color   Future focused methods use clients’ desired future (and often the past) to inform them about what to do next.

Here’s an example: “What’s the next step you’ll take to get the interview for the job you say you want?” If the response is “I have no idea,” your next question can be “Can you remember a recent time when you had no idea about what to do, and then somehow came up with something?” This encourages them to look at their past strengths to consider what to do right now.

Start slow.  Solution focused interventions do not come easy when clients are expressing their genuine suffering.  Use all your basic skills of reflecting, paraphrasing, empathizing and labeling feelings.  Then, give yourself the task of adding one future focused comment or question in each session.

This week, use one future focused intervention.  The easiest is “What do you plan on doing right after you leave this office?” Follow it up with “What are you looking forward to when (or after) you do that.” It may not be a deep therapeutic question, but it’s a way of steering your client toward what’s up next.